Analysis

Guidelines promoting children’s physical and mental well-being largely overlook nurses’ role

The Department for Education has published draft guidance for schools in England to help children manage their academic, personal and social lives and become well-rounded individuals – but the RCN belives it is a mistake not to involve school nurses more 

The Department for Education has published draft guidance for schools in England to help children manage their academic, personal and social lives and become well-rounded individuals – but the RCN belives it is a mistake not to involve school nurses more 


Picture: iStock

Establishing the building blocks to help children grow up happy and healthy is a challenge that has exercised successive governments.

With one in ten children and young people affected by mental health problems, according to the Mental Health Foundation (2018), and Ofsted (2018) reporting that one third of primary school children are overweight or obese, the challenge is enduring and difficult.

To encourage schoolchildren to make informed decisions about well-being, health and relationships that will serve them well in adult life, the Department for Education has published draft guidance for schools in England managing their academic, personal and social lives. The guidance is open for consultation until 7 November.

29%

of school nurses in England were unable to take a break during their last shift
(Source: RCN (2018) The Best Start: The Future of Children’s Health – One Year on)

Challenges of the modern world

At the guidance’s launch, education secretary Damian Hinds said he wanted children to grow up as well-rounded individuals able to deal with the challenges of the modern world.

‘Part of this is making sure they are informed about how to keep themselves safe and healthy and have good relationships with others,’ he said.

Mr Hinds added: ‘Many of today’s problems did not exist when we last gave schools guidance on how to teach relationship and sex education 18 years ago.’

The guidance proposes that teachers talk to primary school children in age-appropriate ways about healthy friendships and family relationships. Children should be taught what a relationship is, what friendship is and what family means, it says.

‘From the beginning of primary school, building on early education, children should be taught how to take turns, how to treat each other with kindness, consideration and respect, the importance of honesty and truthfulness, permission giving and seeking, and the concept of personal privacy.’

Nurturing healthy relationships

The aim of relationships and sex education in secondary schools should be to help pupils learn about ‘healthy, nurturing relationships’, the guidance proposes.

‘It should also cover contraception, developing intimate relationships and resisting (and not applying) pressure to have sex.’

70%

of school nurses in England worked additional time during their last shift
(Source: RCN (2018) The Best Start: The Future of Children’s Health – One Year on)

On physical and mental health, the consultation document discusses the link between the two and proposes that pupils in primary school should be taught the benefits of ‘daily exercise, good nutrition and sufficient sleep’.

Reaction to publication of the draft guidance acknowledged its laudable aims.

Concerns for future generations

The Personal, Social, Health and Economic Association, which represents teachers and other professionals working in personal, social and health education, said that with concerns about young people’s mental and physical health rising, the government’s commitment outlined in the guidance would have a major effect on ‘this generation and generations to come’.

Beat, the eating disorders charity, says the draft guidance recognises the importance of good mental health in children.

‘Measures to improve children’s physical health, such as anti-obesity campaigns, must also consider their mental health and the effect they may have on people vulnerable to eating disorders,’ says Beat director of external affairs Tom Quinn. Doctors are diagnosing more cases of eating disorders than ever before, he adds.

What the Department of Education is aiming to do

The draft guidance from the Department for Education on teaching pupils about health and well-being aims is to encourage informed decision-making and to help children recognise issues early, in themselves and others, and to seek support.

Concepts introduced in primary school should be continued in secondary education, including:

  • Mental well-being
  • Internet safety and harm
  • Physical health and fitness
  • Healthy eating
  • Drugs, alcohol and tobacco
  • Health and prevention, including personal hygiene, dental health, self-examination and the importance of sleep
  • Basic first aid
  • The changing adolescent body

 

The British Youth Council (BYC), a charity that empowers young people to have a say and be heard, has long argued for improved sex and relationships education in schools. BYC chair Anna Rose Barker welcomed the plans laid out in the guidance, saying: ‘Mental health and well-being continue to be a priority for young people and it’s great to see the government taking steps to address the issue within the curriculum.’

Absent nurses

But although the overall aims of the proposals were broadly welcomed by organisations working with children and young people, the RCN expressed misgivings.

School nurses are largely absent from the guidance, even though they are listed as part of its target audience. There is passing reference to nurses as examples of adults in the school community who can offer support to pupils with concerns – but nothing to indicate a substantive role in promoting better health and well-being. And that, says RCN lead for children and young people, Fiona Smith, is a mistake.

2,292

school nurses in England in March 2018, down by 24% since March 2010

(Source: RCN (2018) The Best Start: The Future of Children’s Health – One Year on)

‘We welcome these proposals, which recognise the importance of teaching mental and physical well-being in schools. School nurses and the RCN have been calling for personal social, health and economic education, as well as sex and relationship education, to be a statutory subject, with adequate resourcing and assessment,’ Ms Smith says.

‘However, some children will want to have private and confidential conversations on these subjects. School nurses offer this vital service, and support pupils every day on issues such as safe sex, mental health and childhood obesity.’

Ms Smith adds that children and young people are now needing more help than ever before to make informed choices and yet the number of school nurses is falling. The decline in England has been dramatic – down from 3,012 in March 2010 to 2,292 in March this year, according to NHS statistics, is a fall of 24%.

Do school nurses make a difference to health outcomes?

In a report published earlier this year, the RCN (2018) acknowledged that the evidence base for school nursing at national level is less well developed than, say, for health visiting. But local, targeted interventions based on health-needs assessments have demonstrated the value of investing in school nursing.

‘School nursing services have also been shown to improve the long-term condition management of pupils, resulting in significantly fewer missed school days,’ the report said.

Whether it is possible to properly educate children and young people about sex, health and relationships without input from an adequately staffed school nursing service will become clear after the guidance becomes compulsory in 2020.

But with public health budgets dwindling – and school nursing numbers perhaps falling further – the challenge to shape the ‘happy and well-rounded’ individuals envisioned in the consultation document is likely to be intense.

Click here for the Department of Health draft guidance


References

 

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